BioethicsTV: Aggressive Treatment Chosen for Patients at the End of Life

by Craig Klugman, Ph.D.

This week’s Thursday night medical TV was all about end of life decision-making and delved into the questions of how much aggressive treatment is too much, what happens when physicians lose clinical distance, and who makes decisions for patients.

On Chicago Med (Season 2, Episode 18), a patient with Alzheimer’s is admitted to the ED with a fever and chills. She has pneumonia and has for several days, only being sent to the hospital that day by her long-term care facility. The patient is Dr. Bella Rowen, Halstead’s former mentor and administrator Goodwin’s former colleague (from her nursing days). As the patient is brought in, a nurse says “No advance directive, no family, and the surrogate just passed away, so it’s going to be our call.” Halstead is emotionally invested in his mentor and takes over decision-making for her care. She is frail and does not remember him. When Rowen codes, Halstead pushes CPR even though, as his colleagues tell him, he will break all of her ribs and only cause suffering. He resuscitates and intubates her. We are told that she will never get off the vent. When her kidneys fail, he orders dialysis. Goodwin talks to him and says that such measures will lead Rowen to live the rest of her days on machines, bedridden with sores, and open to infections. Goodwin tells Halstead that the woman he knew was gone and forcing this patient to live would not bring his mentor back.

One of the major ethical issues raised in this case is whether, in fact, Halstead should have been making decisions for the patient.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.